Otolaryngology Coding Alert
Modifier 57 and Billin E/M
Fred F. Banhson, MD, Brevard, N.C.
Answer: The correct answer is modifier -25 (significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure or other service). Modifier -57 (decision for surgery) would be incorrect because it was designed as a response to Medicares introduction of the global package and is intended for surgery that includes a 90-day global period. Although, in theory, one can argue either that 31575 (laryngoscopy, flexible fiberoptic; diagnostic) is a surgical procedure because it is in the surgical section of the CPT manual or diagnostic as per its description, most payers require modifier -57 when the exam resulted in a decision to perform a surgical procedure with a 90-day global period.
When an E/M otherwise leads to a procedure, use modifier -25. Barbara J. Cobuzzi, MBA, CPC, a coding and reimbursement specialist in Lakewood, N.J., notes that some private payers have requested that modifier -57 be used for any surgery, regardless of global days. Therefore, check with your carrier if youre not sure.
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